Key result
Reduced left ventricular ejection fraction (<40%) was independently associated with a higher risk of cerebrovascular events and thromboembolic sources in patients with chronic Chagas cardiomyopathy (HR 3.16).
Why the study?
Although Chagas cardiomyopathy is associated with thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease remain limited.
Does reduced left ventricular ejection fraction predict incident cerebrovascular events and thromboembolic sources in patients with chronic Chagas cardiomyopathy?
Cohort (n=113)
No
Does reduced left ventricular ejection fraction predict incident cerebrovascular events and thromboembolic sources in patients with chronic Chagas cardiomyopathy?
Hazard Ratio: 3.16 (95% CI 1.38–7.25)
Absolute Event Rate: 13.9% vs 2.6%
p-value: p=0.006
In patients with chronic Chagas cardiomyopathy, left ventricular systolic dysfunction (LVEF < 40%) is a strong independent predictor of incident cerebrovascular events and thromboembolic sources.
Lower LVEF was associated with higher cerebrovascular and thromboembolic risk in Chagas cardiomyopathy; supports risk stratification but leaves open need for prospective validation.
BACKGROUND: Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy. METHODS: This retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack-TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up. RESULTS: A total of 113 patients were included. Median age was 56 years (IQR: 45-67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41-62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93-0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38-7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year. CONCLUSIONS: LV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.
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Moreira et al. (2022) conducted a cohort in Chronic Chagas cardiomyopathy (n=113). Reduced left ventricular ejection fraction (<40%) vs. Preserved left ventricular ejection fraction (≥40%) was evaluated on Composite of incident ischemic cerebrovascular events (stroke or TIA) and potential thromboembolic sources (atrial fibrillation, atrial flutter, or intracavitary thrombus) (HR 3.16, 95% CI 1.38-7.25, p=0.006). Reduced left ventricular ejection fraction (<40%) was independently associated with a higher risk of cerebrovascular events and thromboembolic sources in patients with chronic Chagas cardiomyopathy (HR 3.16).
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